ACVIM consensus: antimicrobials in respiratory tract disease

Question 1

What is the current recommendation for antimicrobial treatment in acute feline upper respiratory tract disease

Answer 1

• serous discharge or lack of mucopurulent discharge –> abx not recommended
• purulent/mucopurulent discharge –> period of observation w/o abx, up to 10 days
• purulent/mucopurulent discharge –> start abx within 10 days observation if fever, lethargy, or anorexia –> DOXYCYCLINE 7-10 days
• amoxicillin as alternate first-line option if C.felix and Mycoplasma are not highly suspected
• cefovecine inferior to doxy and clavamox

Question 2

Which formulation of doxycycline is more likely to cause drug-induced esophagitis and resultant esophageal strictures?

Answer 2

doxycycline hyclate (also clindamycin hydrochloride capsules)

Question 3

List the implicated viruses and bacteria in canine infectious respiratory diseae complex

Answer 3

viruses
* canine adenovirus 2
* canine distemper virus
* canine respiratory coronavirus
* canine influenza viruses
* canine herpesvirus
* caine pneumovirus
* canine parainfluenza

bacteria
* B. bronchispetica
* S. equi subspecies zooepidemicus
* Mycoplasma spp.

Question 4

What clinical presentation makes S.qui subspecies zooepidemicus infection more likely?

Answer 4

hemorrhagic pneumonia
sudden death

Question 5

What is the current recommendation for abx therapy in canine infectious respiratory diseae complex?

Answer 5

• hold off on abx and 10 observation period - unless fever, lethargy, inappetence + mucopurulent discharge –> then give doxycyclie for 7-10 days as first-line abx (alternate first-line amoxciclav)

Question 6

What is the current recommendation for performing blood cultures in SA with pneumonia?

Answer 6

consider blood cultures before starting empirical abx as an alternative way to obtain isolates - if transtracheal, endotracheal, or BAL not possible

Question 7

What is the current recommendation for antimicrobial therapy for suspected bacterial pneumonia in SA?

Answer 7

bacterial infectious pneumonia:
* provide empirical parenteral abx while in hospital
* doxycycline first line empirical abx if only mild pneumonia (suspected to be B bronchiseptica or Mycoplasma spp) and no other systemic signs e.g., fever, dehydration, lethargy, respiratory distress

Aspiration pneumonia
* either no abx or parenteral administration or beta-lactam (ampicillin (+/- sulbactam), cefazolin

Duration of treatment: evidence lacking, 10-14 days at least then re-evaluate and decide to extend treatment or not (e.g., 4-6 weeks)

Question 8

What is the current recommendation for abx in suspected bacterial pneumonia with suggested sepsis?

Answer 8

parenteral:
* enrofloxacin/marbofloxacin
PLUS
* ampicillin or clindamycin (i.e., gram-positive + anaerobic spectra

Question 9

What is the current recommendation for treatment of pyothorax in SA?

Answer 9

• IV fluids
• drainage with chest tubes
• +/- surgical debridement as needed

Abx:
* parenteral enrofloxacin/marbofloxacin
* + parenteral penicillin or clindamycin

continue treatment with abx with anaerobic spectrum regardless of culture results because these bacteria are fastidious and may not be cultured successfully

duration of tx 4-6 weeks in cats (minimum 3 weeks)